Chest CT findings in community-acquired pneumonia due to Coxiella burnetii (Q fever) compared to Streptococcus pneumoniae, a cross sectional study in French Guiana, 2013-2017.

OBJECTIVES: Few and small studies previously examined chest CT-scan characteristics of Coxiella burnetii (Cb) community-acquired pneumonia (CAP). Larger studies are needed to guide physicians towards diagnosis of Q fever in case of pneumonia. METHODS: We conducted a single-center retrospective observational study between 2013 and 2017. All patients with Cb or Streptococcus pneumoniae (Sp) CAP who had a chest CT-scan on admission at Cayenne Hospital (French Guiana) were included. Chest CT-scan were all analyzed by the same expert radiologist. RESULTS: We included 75 patients with Cb CAP and 36 with Sp CAP. Fifty-nine percent of all patients were men (n = 66) and median age was 52 [IQR = 38-62]. Chest CT-scans of Cb CAP patients revealed 67 alveolar condensations (89 %), 52 ground-glass opacities (69 %), 30 cases of lymphadenopathy(ies) (40 %) and 25 pleural effusions (33 %). Parenchyma lesions caused by Cb were predominantly unilateral (67 %). We found high numbers of alveolar condensations in both Cb and Sp CAP (89 % and 75 %; respectively), but the presence of ground-glass opacities was significantly associated with Cb CAP (69 % versus 30 %; p < 0.01). Cb CAP were associated with more lymphadenopathies (40 % vs 17 %; p = 0.01) while Sp CAP showed more bronchial thickening (19 % versus 3 %; p < 0.01) and (micro)nodule(s) ≤1 cm (25 % vs 3 %, p < 0.01). CONCLUSIONS: This large study shows that the most typical aspect of chest CT-scan in case of Cb CAP in French Guiana is a unilateral alveolar consolidation associated with ground glass opacities and lymphadenopathies. C. burnetti and S. pneumoniae both most often cause alveolar consolidations, but present some significantly different CT-scan patterns. This could help physicians through therapeutic choices.

Seroprevalence estimate and risk factors for Coxiella burnetii infections among humans in a highly urbanised Brazilian state.

BACKGROUND: Q fever is among the top 13 global priority zoonoses, however, it is still neglected and under-reported in most of the world, including Brazil. Thus, we evaluated the seroprevalence of and the risk factors for Coxiella burnetii infections in humans from Minas Gerais, a highly urbanised Brazilian state. METHODS: Coxiella burnetii was searched for patient samples (n=437), which were suspected of then later confirmed as negative for dengue fever, by the indirect immunofluorescence technique and real-time PCR. Risk factors for infections and spatial clusters for both C. burnetii-seropositive individuals and livestock concentration were evaluated. RESULTS: We found that 21 samples (4.8%; 95% CI 3.0 to 7.2%) were reactive for at least one class of anti-C. burnetii antibodies (titer of ≥64), with rural residence (p=0.036) being a risk factor. Also, two spatial clusters of seropositivity were found within a significant area by Scan, and a probable relationship between the Scan result and the livestock concentration by area was found. CONCLUSIONS: Seropositive individuals were associated with rural residence, with a likely relationship with the livestock concentration. Thus, this study establishes baseline figures for C. burnetii seroprevalence in humans in a state of Brazil, allowing the monitoring of trends and setting of control targets, as well as more representative longitudinal and risk analysis studies.

Q fever epidemic in Cayenne, French Guiana, epidemiologically linked to three-toed sloth.

A Q fever epidemic occurred in 2013 in a small military residential area in Cayenne, French Guiana. A retrospective cohort study was conducted to identify Q fever risk factors. Confirmed acute Q fever case was defined as positive serology (IgM ≥ 50 and phase II IgG ≥ 200) and/or positive qPCR on serum or blood. In addition, wild mammals were captured at the study site and tested by serology and real-time PCR performed on blood, vaginal swabs and ticks. The attack rate was 20 percent (11/54). All the cases were symptomatic with fever >38.5 °C and community-acquired pneumonia for four cases. Log binomial multivariate models identified two independent risk factors associated with Q fever: to clean the house (RRa = 7.5 CI95% [1.03-55.3]) and to carry a three-toed sloth in arms (RRa = 2.6 CI95% [1.1-5.8]). Eighteen marsupial individuals were captured, all PCRs were negative but 17% (3/18) had a positive serology. Another study conducted after the epidemic found only one (1/4) three-tooth sloth (Bradypus tridactylus) with feces highly infectious for C. burnetii MST17. The same strain C. burnetii genotype 17 has been laboratory- confirmed in this mammal and in human cases. These results support the implication of three-toed-sloth in this epidemic. Human contamination mainly occurs through inhalation of infectious aerosols as suggested by high relative risk associated with house cleaning activities and pulmonary forms of the disease, and through direct contact with three- toed-sloth. Positive serological results among marsupials confirm wildlife exposure and suggest a more complex sylvatic transmission cycle among wild mammals.

Evidência sorológica de infecção por Bartonella spp., Coxiella burnetii e Hantavirus em profissionais de um abrigo de animais no município do Rio de Janeiro / Serological evidence of infection with Bartonella spp., Coxiella burnetii and Hantavirus in professional an animal shelter in the city of Rio de Janeiro

O risco de infecção por agentes zoonóticos é considerado maior em profissionais quemanuseiam animais. O crescente aumento de animais abandonados nos grandes centrosurbanos e o seu recolhimento em abrigos, cujas condições sanitárias e de infraestruturasão precárias aumentam o risco de transmissão de tais agentes não somente entre osanimais, mas também para os profissionais, determinando, assim, a ocorrência dezoonoses ocupacionais. Neste cenário, cinco funcionários de um abrigo de animais domunicípio do Rio de Janeiro morreram, após um surto de febre maculosa, e um inquéritosorológico realizado entre os profissionais desse abrigo e nos cães demonstrou queempregados e cães eram sororreativos com elevados títulos sorológicos. Diante doexposto e da necessidade de complementar a pesquisa sobre outros agentes zoonóticosque pudessem estar associados com doença ocupacional, foi realizado um estudo com oobjetivo de investigar a presença de anticorpos anti-Coxiella burnetii, anti-Bartonella,anti-Hantavirus em profissionais de um abrigo, como parte das medidas instituídas nocontexto da vigilância epidemiológica do Laboratório de Hantavirose e Rickettsioses doInstituto Oswaldo Cruz, onde o estudo foi realizado. O resultado da análise mostrou umasoroprevalência de 8,7 por cento (8/92) para febre Q, uma prevalência superior à comparada àsoutras taxas encontradas na população geral brasileira. A prevalência de anticorpos antiBartonellaspp. foi de 1,7 por cento (2/118), muito inferior se comparada às taxas observadas emoutros estudos, principalmente no Brasil onde as taxas são superiores a 30 por cento. Todas as118 amostras foram negativas para hantavirose. Apesar das limitações de um estudoretrospectivo utilizando dados secundários, o presente estudo alerta para a necessidade dese instituir medidas de precauções efetivas nos abrigos de animais para diminuir o riscoocupacional de infecções zoonóticas em profissionais que manuseiam animais...

The risk of zoonotic agents infection is considered higher in professionals who care foranimals. The increasing of abandoned animals in the big cities and your accommodationin shelters (with poor sanitary conditions and inadequate infrastructure) increase the riskof transmission of zoonotic agents not only in animals but also for professionals, thusdetermining the occurrence of occupational zoonoses. In this scenario, five employees ofan animal shelter in a city of Rio de Janeiro died after an outbreak of Rocky Mountainspotted fever, in which a serological survey in the animal shelter workers and dogsdemonstrated that employees and dogs were seroreactive with high titers. Given the aboveand the need for additional research on other zoonotic agents that might be associatedwith occupational disease, an study was conducted in order to investigate the presence ofanti-Coxiella burnetii, anti-Bartonella, anti-Hantavirus in professional na an animalshelter as part of the measures imposed in the contexto of epidemiological surveillanceof Hantavirus and Rickettsiosis Laboratory of the Oswaldo Cruz Institute, where the studywas conducted. The analisys showed a prevalence of 8.7 percent (8/92) for Q fever, a higherprevalence compared to the other rates found in the general Brasilian population. Theprevalence of antibodies anti-Bartonella spp. was 1.7 percent (2/118), much lower comparedto rates observed in other studies, particularly in Brazil where rates above 30 percent. All 118samples were negative for hantavirus. Despite the limitations of a retrospective studyusing secondary data, this study points to the need establish effective precautionmeansures in animal shelters to reduce occupational risk of zoonotic infections inprofessionals who care for animals...

Fiebre Q / Q fever

Q fever is caused by the rickettsia Coxiella burneti, an obligate intracelullar parasite microorganism. It usually takes the form of an acute systemic disease with sudden onset and symptoms of general malaise, chills and fever, myalgia and most chracteristically, severe headache. An interstitial pneumonia usually develops, the febrile period may last from 5 to 25 days or longer. Q fever is primarily a zoonosis an it is tipically an inapparent infection which is solidly established in domestic livestock the world over. Man is incidental to the natural maintenance of the disease whose principal animal reservoirs are ungulaes, rodents and in Australia, marsupials Tetracycline is the antibiotic preferred for Q fever therapy, it is administered orally (2.5 to 4 ger per day) divided in 4 dosis. Human cases of Q fever have been reported in all Latin american countries. Most human infection are derived from infected livestock, thus individuals such as slaughterhouse and dairy workers, herders, tanners, etc. should be protected

Fiebre Q / Q fever

Q fever is caused by the rickettsia Coxiella burneti, an obligate intracelullar parasite microorganism. It usually takes the form of an acute systemic disease with sudden onset and symptoms of general malaise, chills and fever, myalgia and most chracteristically, severe headache. An interstitial pneumonia usually develops, the febrile period may last from 5 to 25 days or longer. Q fever is primarily a zoonosis an it is tipically an inapparent infection which is solidly established in domestic livestock the world over. Man is incidental to the natural maintenance of the disease whose principal animal reservoirs are ungulaes, rodents and in Australia, marsupials Tetracycline is the antibiotic preferred for Q fever therapy, it is administered orally (2.5 to 4 ger per day) divided in 4 dosis. Human cases of Q fever have been reported in all Latin american countries. Most human infection are derived from infected livestock, thus individuals such as slaughterhouse and dairy workers, herders, tanners, etc. should be protected (AU)